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Fenestration of liver cysts in polycystic liver disease to improve quality of life: a case report and literature review.

Jung DH, Hwang S, Ahn CS, Moon DB, Song GW, Kim KH, Ha TY, Park GC, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery.The total liver volume was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%.After surgery, her performance status improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Polycystic liver disease (PCLD) is characterized by a large number of liver cysts scattered throughout the liver parenchyma. We herein intend to present the beneficial effect of palliative fenestration treatment on quality of life in a patient with symptomatic PCLD. A 48-year-old female patient had been followed up for 5 years for both polycystic liver and kidney diseases at another institution. During follow-up for last 1 year, we recognized that she had barely maintained her ability of function in daily activities due to progressive worsening of fatigue and dyspnea on exertion. The patient finally underwent surgical fenestration treatment. Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery. No surgical complication occurred and the patient was discharged 10 days after the open fenestration surgery. The total liver volume was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%. After surgery, her performance status improved significantly. In the present case, significant improvement in quality of life and daily activity performance was achieved after open fenestration treatment over 18 months of follow-up without disease recurrence.

No MeSH data available.


Related in: MedlinePlus

Operative findings of the patient undergoing open fenestration surgery. Enlarged liver was bulged out of the abdomen (A); There were numerous liver cysts, but the majority of liver parenchyma was preserved (B); Fenestration of the liver cyst led to moderate reduction of the whole liver volume (C); Bulging mass in the abdomen disappeared at the time of abdominal wall closure (D).
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Figure 4: Operative findings of the patient undergoing open fenestration surgery. Enlarged liver was bulged out of the abdomen (A); There were numerous liver cysts, but the majority of liver parenchyma was preserved (B); Fenestration of the liver cyst led to moderate reduction of the whole liver volume (C); Bulging mass in the abdomen disappeared at the time of abdominal wall closure (D).

Mentions: After obtaining consent of the patient on the uncertain effect of fenestration treatment as well as high risk of disease recurrence, the patient underwent surgical fenestration treatment. Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery (Fig. 4). To avoid bleeding and bile leakage, the thin membranous portions were meticulously fenestrated and none of the viable normal liver parenchyma was resected. The majority of accessible liver cysts were opened. At the end of the fenestration procedure, the liver appeared to be markedly shrunken. Three Jackson-Pratt type drains were inserted to evacuate the ascitic fluid: the abdominal drainage output was about 500 ml/day at postoperative day 1 and then it gradually decreased to less than 150 ml/day after 5 days. After performing follow-up CT at 1 week, the drains were removed. No surgical complication occurred and the patient was discharged 10 days after the open fenestration surgery. The total liver volume by using CT volumetry was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%.


Fenestration of liver cysts in polycystic liver disease to improve quality of life: a case report and literature review.

Jung DH, Hwang S, Ahn CS, Moon DB, Song GW, Kim KH, Ha TY, Park GC, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Operative findings of the patient undergoing open fenestration surgery. Enlarged liver was bulged out of the abdomen (A); There were numerous liver cysts, but the majority of liver parenchyma was preserved (B); Fenestration of the liver cyst led to moderate reduction of the whole liver volume (C); Bulging mass in the abdomen disappeared at the time of abdominal wall closure (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494095&req=5

Figure 4: Operative findings of the patient undergoing open fenestration surgery. Enlarged liver was bulged out of the abdomen (A); There were numerous liver cysts, but the majority of liver parenchyma was preserved (B); Fenestration of the liver cyst led to moderate reduction of the whole liver volume (C); Bulging mass in the abdomen disappeared at the time of abdominal wall closure (D).
Mentions: After obtaining consent of the patient on the uncertain effect of fenestration treatment as well as high risk of disease recurrence, the patient underwent surgical fenestration treatment. Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery (Fig. 4). To avoid bleeding and bile leakage, the thin membranous portions were meticulously fenestrated and none of the viable normal liver parenchyma was resected. The majority of accessible liver cysts were opened. At the end of the fenestration procedure, the liver appeared to be markedly shrunken. Three Jackson-Pratt type drains were inserted to evacuate the ascitic fluid: the abdominal drainage output was about 500 ml/day at postoperative day 1 and then it gradually decreased to less than 150 ml/day after 5 days. After performing follow-up CT at 1 week, the drains were removed. No surgical complication occurred and the patient was discharged 10 days after the open fenestration surgery. The total liver volume by using CT volumetry was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%.

Bottom Line: Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery.The total liver volume was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%.After surgery, her performance status improved significantly.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Polycystic liver disease (PCLD) is characterized by a large number of liver cysts scattered throughout the liver parenchyma. We herein intend to present the beneficial effect of palliative fenestration treatment on quality of life in a patient with symptomatic PCLD. A 48-year-old female patient had been followed up for 5 years for both polycystic liver and kidney diseases at another institution. During follow-up for last 1 year, we recognized that she had barely maintained her ability of function in daily activities due to progressive worsening of fatigue and dyspnea on exertion. The patient finally underwent surgical fenestration treatment. Multiple cysts in the enlarged liver were opened and the cyst walls were excised with electrocautery. No surgical complication occurred and the patient was discharged 10 days after the open fenestration surgery. The total liver volume was 3,870 ml before surgery and 3,125 ml at 1 week after surgery, showing a volume reduction of 19.3%. After surgery, her performance status improved significantly. In the present case, significant improvement in quality of life and daily activity performance was achieved after open fenestration treatment over 18 months of follow-up without disease recurrence.

No MeSH data available.


Related in: MedlinePlus